Registration Form
PKU Cruise
Carnival Triumph
July 18, 2002
LEGAL NAME #1:_________________________________________________
Address: __________________________________________________________
_________________________________________________________________
Phone #: (____)_______________ (home) (____)____________________ (work)
Birth Date: ________________ PKU DIET: ______ (yes) _____ (no)
LEGAL NAME #2:_________________________________________________
Address: __________________________________________________________
_________________________________________________________________
Phone #: (____)_______________ (home) (____)____________________ (work)
Birth Date: ________________ PKU DIET: ______ (yes) _____ (no)
LEGAL NAME #3:_________________________________________________
Birth Date: ________________ PKU DIET: ______ (yes) ______ (no)
LEGAL NAME #4:_________________________________________________
Birth Date: ________________ PKU DIET: ______ (yes) _____ (no)
CATEGORY CABIN: ___________
$100 PER PERSON DEPOSIT
Due by June 25, 2001
Please send check payable to Cruise Holidays or call me with a credit card deposit:
Cruise Holidays
Attention: Pat Byrne
104-A West Germantown Pike
Norristown, PA 19401
(610) 277-6850